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Zhang L, Lu F, Wang Y, Ji J, Xu Y, Huang Y, Zhang M, Li M, Xia J, Wang B. Methodological comparison of bronchoalveolar lavage fluid-based detection of respiratory pathogens in diagnosis of bacterium/fungus-associated pneumonia in critically ill patients. Front Public Health 2023; 11:1168812. [PMID: 37255757 PMCID: PMC10225631 DOI: 10.3389/fpubh.2023.1168812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/12/2023] [Indexed: 06/01/2023] Open
Abstract
Background Bacterium/fungus-associated pneumonia (BAP/FAP) is the prominent cause of high mortality and morbidity with important clinical impacts globally. Effective diagnostic methods and proper specimen types hopefully facilitate early diagnosis of pneumonia and prevent spread of drug-resistant bacteria/fungi among critically ill patients. Methods In the present study, 342 bronchoalveolar lavage fluid (BALF) samples were collected from critically ill patients with pulmonary infections between November 2020 and March 2021. The BALF materials were comparatively employed to screen BAP/FAP through microscopy, culture, antigenic marker and PCR-based methods. The limit of detection (LOD) of cultures and PCR for bacteria/fungi was determined by serial dilution assays. Specimen slides were prepared with Gram staining for microscopic examinations. Microbial cultures and identifications underwent routine clinical protocols with the aid of mass spectrometry. (1,3)-β-D-glucan and galactomannan tests with BALF were carried out accordingly. Direct detection of pathogens in BALF was achieved through PCR, followed by sequencing and BLAST in GenBank database for pathogenic identification. The subjects' demographic and clinical characteristics were well evaluated. Results BAP/FAP was identified in approximately 47% of the subjects by the BALF-based PCR. The PCR-based diagnostic methods showed improved detection performance for fungi with good LOD, but performed similarly for bacteria, when compared to the cultures. There was poor agreement among traditional microscopy, culture and PCR assays for bacterial detections (kappa value, 0.184 to 0.277). For overall bacterial/fungal detections, the microscopy showed the lowest detecting rate, followed by the cultures, which displayed a slightly higher sensitivity than the microscopy did. The sensitivity of PCR was much higher than that of the other means of interest. However, the traditional cultures rather than antigenic marker-based approaches were moderately consistent with the PCR-based methods in fungal species identification, particularly for Candida and Aspergillus spp. Our findings further revealed that the age, length of hospital stay, invasive procedures and cerebral diseases were likely considered as main risk factors for BAP/FAP. Conclusion Screening for BALF in critically ill patients with suspected pneumonia pertaining high risk factors using combined PCR-based molecular detection strategies would hopefully contribute to early diagnosis of BAP/FAP and improved prognosis of the patients.
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Affiliation(s)
- Luwen Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Fanbo Lu
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yuerong Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
- Institute of Pediatrics, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Juanjuan Ji
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yuanhong Xu
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Ying Huang
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Min Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Moyan Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jinxing Xia
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Bo Wang
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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Egger M, Bellmann R, Krause R, Boyer J, Jakšić D, Hoenigl M. Salvage Treatment for Invasive Aspergillosis and Mucormycosis: Challenges, Recommendations and Future Considerations. Infect Drug Resist 2023; 16:2167-2178. [PMID: 37077251 PMCID: PMC10106327 DOI: 10.2147/idr.s372546] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/23/2023] [Indexed: 04/21/2023] Open
Abstract
Invasive mold diseases are devastating systemic infections which demand meticulous care in selection, dosing, and therapy monitoring of antifungal drugs. Various circumstances regarding PK/PD properties of the applied drug, resistance/tolerance of the causative pathogen or host intolerability can lead to failure of the initial antifungal therapy. This necessitates treatment adaption in the sense of switching antifungal drug class or potentially adding another drug for a combination therapy approach. In the current state of drastically limited options of antifungal drug classes adaption of therapy remains challenging. Current guidelines provide restricted recommendations only and emphasize individual approaches. However, novel antifungals, incorporating innovative mechanisms of action, show promising results in late stage clinical development. These will expand options for salvage therapy in the future potentially as monotherapy or in combination with conventional or other novel antifungals. We outline current recommendations for salvage therapy including PK/PD considerations as well as elucidate possible future treatment options for invasive aspergillosis and mucormycosis.
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Affiliation(s)
- Matthias Egger
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Biotechmed-Graz, Graz, Austria
| | - Romuald Bellmann
- Clinical Pharmacokinetics Unit, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Robert Krause
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Biotechmed-Graz, Graz, Austria
| | - Johannes Boyer
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Daniela Jakšić
- Department of Microbiology, Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia
| | - Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Biotechmed-Graz, Graz, Austria
- Clinical and Translational Fungal-Working Group, University of California San Diego, San Diego, CA, USA
- Translational Medical Mycology Research Unit, ECMM Excellence Center for Medical Mycology, Medical University of Graz, Graz, Austria
- Correspondence: Martin Hoenigl, Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Auenbruggerplatz 15, Graz, 8036, Austria, Tel +43 31638531425, Email
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Ma X, Zhang S, Xing H, Li H, Chen J, Li H, Jiao M, Shi Q, Xu A, Xing L, Cao W. Invasive Pulmonary Aspergillosis Diagnosis via Peripheral Blood Metagenomic Next-Generation Sequencing. Front Med (Lausanne) 2022; 9:751617. [PMID: 35402461 PMCID: PMC8987774 DOI: 10.3389/fmed.2022.751617] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 02/17/2022] [Indexed: 11/13/2022] Open
Abstract
Invasive pulmonary aspergillosis (IPA) is one of the major causes of morbidity and mortality in immunocompromised patients such as hematological malignancies, hematopoietic stem cell transplantation, and solid organ transplantation. The diagnosis of IPA in these patients is still difficult because it has no obvious specificity in clinical symptoms, signs and imaging, and test sensitivity of blood 1,3-β-d-glucan test, galactomannan are low. Therefore, we still need to explore more diagnostic methods. In our study, via peripheral blood metagenomic next-generation sequencing (mNGS), five patients were tested positive for Aspergillus DNA and then quickly diagnosed as IPA. Out of the 5 cases, 1 was proven and 4 were probable IPA. The underlying diseases of the 5 patients were myelodysplastic syndrome (2 cases), acute myeloid leukemia (2 cases), and renal transplantation (1 case). Then they were diagnosed as IPA using other methods such as lung histopathology, bronchoalveolar lavage fluid (BALF) mNGS, and sputum culture or sputum mNGS. In case 1, sputum culture suggested Aspergillus flavus. In case 2, both Grocott methenamine silver (GMS) stain of lung histopathology and lung tissue mNGS suggested Aspergillus infection. In cases 3 and 4, BALF-mNGS suggested Aspergillus infection. In case 5, sputum mNGS suggested Aspergillus infection. In conclusion, detecting the cfDNA of Aspergillus via peripheral blood mNGS can be used to diagnose IPA and is a rapid and non-invasive diagnosis method.
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Affiliation(s)
- Xiaoxu Ma
- Department of Respiration, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Suping Zhang
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haizhou Xing
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huiling Li
- Department of Respiration, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jiajun Chen
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Haijun Li
- Department of Clinical Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengfan Jiao
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Gene Hospital of Henan , Precision Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qingmiao Shi
- Department of Infectious Diseases, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Gene Hospital of Henan , Precision Medicine Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Aiguo Xu
- Department of Respiration, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lihua Xing
- Department of Respiration, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Weijie Cao
- Department of Hematology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Weijie Cao
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Xu J, Yang X, Lv Z, Zhou T, Liu H, Zou X, Cao F, Zhang L, Liu B, Chen W, Yu Y, Shu H, Yuan S, Hu M, Huang C, Shang Y. Risk Factors for Invasive Aspergillosis in Patients Admitted to the Intensive Care Unit With Coronavirus Disease 2019: A Multicenter Retrospective Study. Front Med (Lausanne) 2021; 8:753659. [PMID: 34869450 PMCID: PMC8635191 DOI: 10.3389/fmed.2021.753659] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/19/2021] [Indexed: 01/08/2023] Open
Abstract
Background: Invasive pulmonary aspergillosis (IPA) is a life-threatening complication in coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs), but risk factors for COVID-19-associated IPA (CAPA) have not been fully characterized. The aim of the current study was to identify factors associated with CAPA, and assess long-term mortality. Methods: A retrospective cohort study of adult COVID-19 patients admitted to ICUs from six hospitals was conducted in Hubei, China. CAPA was diagnosed via composite clinical criteria. Demographic information, clinical variables, and 180-day outcomes after the diagnosis of CAPA were analyzed. Results: Of 335 critically ill patients with COVID-19, 78 (23.3%) developed CAPA within a median of 20.5 days (range 13.0-42.0 days) after symptom onset. Compared to those without CAPA, CAPA patients were more likely to have thrombocytopenia (50 vs. 19.5%, p < 0.001) and secondary bacterial infection prior to being diagnosed with CAPA (15.4 vs. 6.2%, p = 0.013), and to receive vasopressors (37.2 vs. 8.6%, p < 0.001), higher steroid dosages (53.9 vs. 34.2%, p = 0.002), renal replacement therapy (37.2 vs. 13.6%, p < 0.001), and invasive mechanical ventilation (57.7 vs. 35.8%, p < 0.001). In multivariate analysis incorporating hazard ratios (HRs) and confidence intervals (CIs), thrombocytopenia (HR 1.98, 95% CI 1.16-3.37, p = 0.012), vasopressor use (HR 3.57, 95% CI 1.80-7.06, p < 0.001), and methylprednisolone use at a daily dose ≥ 40 mg (HR 1.69, 95% CI 1.02-2.79, p = 1.02-2.79) before CAPA diagnosis were independently associated with CAPA. Patients with CAPA had longer median ICU stays (17 days vs. 12 days, p = 0.007), and higher 180-day mortality (65.4 vs. 33.5%, p < 0.001) than those without CAPA. Conclusions: Thrombocytopenia, vasopressor use, and corticosteroid treatment were significantly associated with increased risk of incident IPA in COVID-19 patients admitted to ICUs. The occurrence of CAPA may increase the likelihood of long-term COVID-19 mortality.
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Affiliation(s)
- Jiqian Xu
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Research Center for Translational Medicine, Jinyintan Hospital, Wuhan, China.,Institute of Anesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaobo Yang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Lv
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ting Zhou
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong Liu
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Research Center for Translational Medicine, Jinyintan Hospital, Wuhan, China
| | - Xiaojing Zou
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Fengsheng Cao
- Department of Critical Care Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Lu Zhang
- Department of Critical Care Medicine, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China
| | - Boyi Liu
- Department of Critical Care Medicine, Taihe Hospital Affiliated to Hubei University Medicine, Shiyan, China
| | - Wei Chen
- Department of Critical Care Medicine, Taihe Hospital Affiliated to Hubei University Medicine, Shiyan, China
| | - Yuan Yu
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huaqing Shu
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shiying Yuan
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ming Hu
- Department of Critical Care Medicine, Wuhan Pulmonary Hospital, Wuhan, China
| | - Chaolin Huang
- Research Center for Translational Medicine, Jinyintan Hospital, Wuhan, China
| | - You Shang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Research Center for Translational Medicine, Jinyintan Hospital, Wuhan, China.,Institute of Anesthesiology and Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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5
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COVID-19-Associated Invasive Aspergillosis: Data from the UK National Mycology Reference Laboratory. J Clin Microbiol 2020; 59:JCM.02136-20. [PMID: 33087440 PMCID: PMC7771443 DOI: 10.1128/jcm.02136-20] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/17/2020] [Indexed: 12/21/2022] Open
Abstract
COVID-19-associated pulmonary aspergillosis (CAPA) was recently reported as a potential infective complication affecting critically ill patients with acute respiratory distress syndrome following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with incidence rates varying from 8 to 33% depending on the study. However, definitive diagnosis of CAPA is challenging. Standardized diagnostic algorithms and definitions are lacking, clinicians are reticent to perform aerosol-generating bronchoalveolar lavages for galactomannan testing and microscopic and cultural examination, and questions surround the diagnostic sensitivity of different serum biomarkers. COVID-19-associated pulmonary aspergillosis (CAPA) was recently reported as a potential infective complication affecting critically ill patients with acute respiratory distress syndrome following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with incidence rates varying from 8 to 33% depending on the study. However, definitive diagnosis of CAPA is challenging. Standardized diagnostic algorithms and definitions are lacking, clinicians are reticent to perform aerosol-generating bronchoalveolar lavages for galactomannan testing and microscopic and cultural examination, and questions surround the diagnostic sensitivity of different serum biomarkers. Between 11 March and 14 July 2020, the UK National Mycology Reference Laboratory received 1,267 serum and respiratory samples from 719 critically ill UK patients with COVID-19 and suspected pulmonary aspergillosis. The laboratory also received 46 isolates of Aspergillus fumigatus from COVID-19 patients (including three that exhibited environmental triazole resistance). Diagnostic tests performed included 1,000 (1-3)-β-d-glucan and 516 galactomannan tests on serum samples. The results of this extensive testing are presented here. For a subset of 61 patients, respiratory specimens (bronchoalveolar lavage specimens, tracheal aspirates, and sputum samples) in addition to serum samples were submitted and subjected to galactomannan testing, Aspergillus-specific PCR, and microscopy and culture. The incidence of probable/proven and possible CAPA in this subset of patients was approximately 5% and 15%, respectively. Overall, our results highlight the challenges in biomarker-driven diagnosis of CAPA, especially when only limited clinical samples are available for testing, and the importance of a multimodal diagnostic approach involving regular and repeat testing of both serum and respiratory samples.
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Jenks JD, Miceli MH, Prattes J, Mercier T, Hoenigl M. The Aspergillus Lateral Flow Assay for the Diagnosis of Invasive Aspergillosis: an Update. CURRENT FUNGAL INFECTION REPORTS 2020; 14:378-383. [PMID: 33312332 PMCID: PMC7717101 DOI: 10.1007/s12281-020-00409-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2020] [Indexed: 12/17/2022]
Abstract
Purpose of Review To review the data on the Aspergillus lateral flow assay for the diagnosis of invasive Aspergillosis. Recent Findings Aspergillus spp. cause a wide spectrum of disease with invasive aspergillosis (IA) as its most severe manifestation. Early and reliable diagnosis of disease is crucial to decrease associated morbidity and mortality, and enable prompt initiation of treatment for IA. Most recently, non-culture-based tests, such as Aspergillus galactomannan (GM), have been useful in early identification and treatment of patients with IA. However, cost, turnaround time, and variable performance indifferent populations at risk for IA remain significant drawbacks to the use of this test. Several diagnostic tests for IA have been developed, including the sōna Aspergillus GM Lateral flow assay (GM-LFA) rapid test. Summary The GM-LFA has shown excellent performance for the diagnosis of IA in patients with hematologic malignancy and may be a viable option for settings where ELISA GM testing is not feasible. Further evaluation of the GM-LFA in the non-hematology setting is ongoing, including in solid organ transplant recipients and patients in the intensive care unit.
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Affiliation(s)
- Jeffrey D. Jenks
- Division of General Internal Medicine, University of California San Diego, La Jolla, CA USA
- Division of Infectious Diseases and Global Health, University of California San Diego, La Jolla, CA USA
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA USA
| | - Marisa H. Miceli
- Division of Infectious Diseases, Department of Medicine, University of Michigan, Ann Arbor, MI USA
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Toine Mercier
- Department of Hematology, University Hospitals Leuven, 3000 Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, KU Leuven, 3000 Leuven, Belgium
| | - Martin Hoenigl
- Division of Infectious Diseases and Global Health, University of California San Diego, La Jolla, CA USA
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA USA
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, 8036 Graz, Austria
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Diagnostic Accuracy of Bronchoalveolar Lavage Fluid Galactomannan for Invasive Aspergillosis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:5434589. [PMID: 33335924 PMCID: PMC7723495 DOI: 10.1155/2020/5434589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 09/13/2020] [Accepted: 11/03/2020] [Indexed: 01/23/2023]
Abstract
Background The pathogenesis of invasive aspergillosis (IA) is still unknown, but its progression is rapid and mortality rate remains high. Bronchoalveolar lavage fluid (BALF) galactomannan (GM) analysis has been used to diagnose IA. This study is aimed at making an accurate estimate of the whole accuracy of BALF-GM in diagnosing IA. Methods After a systematic review of the study, a bivariate meta-analysis was used to summarize the specificity (SPE), the sensitivity (SEN), the positive likelihood ratios (PLR), and the negative likelihood ratios (NLR) of BALF-GM in diagnosing IA. The overall test performance was summarized using a layered summary receiver operating characteristic (SROC) curve. Subgroup analysis was performed to explore the heterogeneity between studies. Results A total of 65 studies that are in line with the inclusion criteria were included. The summary estimates of BALF-GM analysis are divided into four categories. The first is the proven+probable vs. possible+no IA, with an SPE, 0.87 (95% CI, 0.85-0.98); SEN, 0.81 (95% CI, 0.76-0.84); PLR, 9.78 (5.78-16.56); and NLR, 0.20 (0.14-0.29). The AUC was 0.94. The BALF-GM test for proven+probable vs. no IA showed SPE, 0.88 (95% CI, 0.87-0.90); SEN, 0.82 (95% CI, 0.78-0.85); PLR, 6.56 (4.93-8.75); and NLR, 0.24 (0.17-0.33). The AUC was 0.93. The BALF-GM test for proven+probable+possible vs. no IA showed SPE, 0.82 (95% CI, 0.79-0.95); SEN, 0.59 (95% CI, 0.55-0.63); PLR, 3.60 (2.07-6.25); and NLR, 0.31 (0.15-0.61). The AUC was 0.86. The analyses for others showed SPE, 0.85 (95% CI, 0.83-0.87); SEN, 0.89 (95% CI, 0.86-0.91); PLR, 6.91 (4.67-10.22); and NLR, 0.18 (0.13-0.26). The AUC was 0.94. Conclusions The findings of this BALF-GM test resulted in some impact on the diagnosis of IA. The BALF-GM assay is considered a method for diagnosing IA with high SEN and SPE. However, the patients' underlying diseases may affect the accuracy of diagnosis. When the cutoff is greater than 1, the sensitivity will be higher.
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Lipopolysaccharide Binding Protein and Bactericidal/Permeability-Increasing Protein as Biomarkers for Invasive Pulmonary Aspergillosis. J Fungi (Basel) 2020; 6:jof6040304. [PMID: 33233831 PMCID: PMC7712449 DOI: 10.3390/jof6040304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 12/18/2022] Open
Abstract
Early diagnosis of invasive pulmonary aspergillosis (IPA) is crucial to prevent lethal disease in immunocompromized hosts. So far, lipopolysaccharide binding protein (LBP) and bactericidal/permeability-increasing protein (BPI) levels have not been evaluated as biomarkers for IPA. IL-8, previously introduced as a biomarker for IPA, was also included in this study. Bronchoalveolar lavage fluid (BALF) of IPA patients and control patients with non-infectious lung disease was collected according to clinical indications. Measurements in BALF displayed significantly higher levels of LBP (p < 0.0001), BPI (p = 0.0002) and IL-8 (p < 0.0001) in IPA compared to control patients. Receiver operating characteristic curve analysis revealed higher AUC for LBP (0.98, 95% CI 0.95–1.00) than BPI (0.84, 95% CI 0.70–0.97; p = 0.0301). Although not significantly different, AUC of IL-8 (0.93, 95% CI 0.85–1.00) also tended to be higher than AUC for BPI (p = 0.0624). When the subgroup of non-hematological patients was analyzed, test performance of LBP (AUC 0.99, 95% CI 0.97–1.00), BPI (AUC 0.97, 95% CI 0.91–1.00) and IL-8 (AUC 0.96, 95% CI: 0.90–1.00) converged. In conclusion, LBP and—to a lesser extend—BPI displayed high AUCs that were comparable to those of IL-8 for diagnosis of IPA in BALF. Further investigations are worthwhile, especially in non-hematological patients in whom sensitive biomarkers for IPA are lacking.
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Diagnosis of Breakthrough Fungal Infections in the Clinical Mycology Laboratory: An ECMM Consensus Statement. J Fungi (Basel) 2020; 6:jof6040216. [PMID: 33050598 PMCID: PMC7712958 DOI: 10.3390/jof6040216] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/06/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022] Open
Abstract
Breakthrough invasive fungal infections (bIFI) cause significant morbidity and mortality. Their diagnosis can be challenging due to reduced sensitivity to conventional culture techniques, serologic tests, and PCR-based assays in patients undergoing antifungal therapy, and their diagnosis can be delayed contributing to poor patient outcomes. In this review, we provide consensus recommendations on behalf of the European Confederation for Medical Mycology (ECMM) for the diagnosis of bIFI caused by invasive yeasts, molds, and endemic mycoses, to guide diagnostic efforts in patients receiving antifungals and support the design of future clinical trials in the field of clinical mycology. The cornerstone of lab-based diagnosis of breakthrough infections for yeast and endemic mycoses remain conventional culture, to accurately identify the causative pathogen and allow for antifungal susceptibility testing. The impact of non-culture-based methods are not well-studied for the definite diagnosis of breakthrough invasive yeast infections. Non-culture-based methods have an important role for the diagnosis of breakthrough invasive mold infections, in particular invasive aspergillosis, and a combination of testing involving conventional culture, antigen-based assays, and PCR-based assays should be considered. Multiple diagnostic modalities, including histopathology, culture, antibody, and/or antigen tests and occasionally PCR-based assays may be required to diagnose breakthrough endemic mycoses. A need exists for diagnostic tests that are effective, simple, cheap, and rapid to enable the diagnosis of bIFI in patients taking antifungals.
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Schütt J, Sandoval Bojorquez DI, Avitabile E, Oliveros Mata ES, Milyukov G, Colditz J, Delogu LG, Rauner M, Feldmann A, Koristka S, Middeke JM, Sockel K, Fassbender J, Bachmann M, Bornhäuser M, Cuniberti G, Baraban L. Nanocytometer for smart analysis of peripheral blood and acute myeloid leukemia: a pilot study. NANO LETTERS 2020; 20:6572-6581. [PMID: 32786943 DOI: 10.1021/acs.nanolett.0c02300] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
We realize an ultracompact nanocytometer for real-time impedimetric detection and classification of subpopulations of living cells. Nanoscopic nanowires in a microfluidic channel act as nanocapacitors and measure in real time the change of the amplitude and phase of the output voltage and, thus, the electrical properties of living cells. We perform the cell classification in the human peripheral blood (PBMC) and demonstrate for the first time the possibility to discriminate monocytes and subpopulations of lymphocytes in a label-free format. Further, we demonstrate that the PBMC of acute myeloid leukemia and healthy samples grant the label free identification of the disease. Using the algorithm based on machine learning, we generated specific data patterns to discriminate healthy donors and leukemia patients. Such a solution has the potential to improve the traditional diagnostics approaches with respect to the overall cost and time effort, in a label-free format, and restrictions of the complex data analysis.
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Affiliation(s)
- Julian Schütt
- Max Bergmann Center of Biomaterials and Institute for Materials Science, Dresden University of Technology, Budapesterstrasse 27, 01069 Dresden, Germany
- Institute of Ion Beam Physics and Materials Research, Helmholtz-Zentrum Dresden-Rossendorf e.V., Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - Diana Isabel Sandoval Bojorquez
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf e.V., Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - Elisabetta Avitabile
- Department of Chemistry and Pharmacy, University of Sassari, via muroni 23, 07100 Sassari, Italy
| | - Eduardo Sergio Oliveros Mata
- Max Bergmann Center of Biomaterials and Institute for Materials Science, Dresden University of Technology, Budapesterstrasse 27, 01069 Dresden, Germany
- Institute of Ion Beam Physics and Materials Research, Helmholtz-Zentrum Dresden-Rossendorf e.V., Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - Gleb Milyukov
- Samsung R&D Institute Russia (SRR), 127018 Moscow, Russia
| | - Juliane Colditz
- Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Lucia Gemma Delogu
- Department of Chemistry and Pharmacy, University of Sassari, via muroni 23, 07100 Sassari, Italy
- Department of Biomedical Sciences, University of Padua, via Ugo bassi 58, 35122 Padua, Italy
| | - Martina Rauner
- Medizinische Klinik und Poliklinik III, Universitätsklinikum Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Anja Feldmann
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf e.V., Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - Stefanie Koristka
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf e.V., Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - Jan Moritz Middeke
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Katja Sockel
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus Dresden, 01307 Dresden, Germany
| | - Jürgen Fassbender
- Institute of Ion Beam Physics and Materials Research, Helmholtz-Zentrum Dresden-Rossendorf e.V., Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - Michael Bachmann
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf e.V., Bautzner Landstrasse 400, 01328 Dresden, Germany
| | - Martin Bornhäuser
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Carl Gustav Carus Dresden, 01307 Dresden, Germany
- Else Kröner-Fresenius Center for Digital Health (EKFZ), Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Gianaurelio Cuniberti
- Max Bergmann Center of Biomaterials and Institute for Materials Science, Dresden University of Technology, Budapesterstrasse 27, 01069 Dresden, Germany
- Center for Advancing Electronics Dresden (cfaed), Technische Universität Dresden, 01069 Dresden, Germany
- Dresden Center for Computational Materials Science (DCMS), TU Dresden, 01062 Dresden, Germany
- Else Kröner-Fresenius Center for Digital Health (EKFZ), Technische Universität Dresden (TU Dresden), Dresden, Germany
| | - Larysa Baraban
- Max Bergmann Center of Biomaterials and Institute for Materials Science, Dresden University of Technology, Budapesterstrasse 27, 01069 Dresden, Germany
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf e.V., Bautzner Landstrasse 400, 01328 Dresden, Germany
- Center for Advancing Electronics Dresden (cfaed), Technische Universität Dresden, 01069 Dresden, Germany
- Else Kröner-Fresenius Center for Digital Health (EKFZ), Technische Universität Dresden (TU Dresden), Dresden, Germany
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11
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A Collaborative Tale of Diagnosing and Treating Chronic Pulmonary Aspergillosis, from the Perspectives of Clinical Microbiologists, Surgical Pathologists, and Infectious Disease Clinicians. J Fungi (Basel) 2020; 6:jof6030106. [PMID: 32664547 PMCID: PMC7558816 DOI: 10.3390/jof6030106] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic pulmonary aspergillosis (CPA) refers to a spectrum of Aspergillus-mediated disease that is associated with high morbidity and mortality, with its true prevalence vastly underestimated. The diagnosis of CPA includes characteristic radiographical findings in conjunction with persistent and systemic symptoms present for at least three months, and evidence of Aspergillus infection. Traditionally, Aspergillus infection has been confirmed through histopathology and microbiological studies, including fungal culture and serology, but these methodologies have limitations that are discussed in this review. The treatment of CPA requires an individualized approach and consideration of both medical and surgical options. Most Aspergillus species are considered susceptible to mold-active triazoles, echinocandins, and amphotericin B; however, antifungal resistance is emerging and well documented, demonstrating the need for novel therapies and antifungal susceptibility testing that correlates with clinical response. Here, we describe the clinical presentation, diagnosis, and treatment of CPA, with an emphasis on the strengths and pitfalls of diagnostic and treatment approaches, as well as future directions, including whole genome sequencing and metagenomic sequencing. The advancement of molecular technology enables rapid and precise species level identification, and the determination of molecular mechanisms of resistance, bridging the clinical infectious disease, anatomical pathology, microbiology, and molecular biology disciplines.
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12
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Arastehfar A, Carvalho A, van de Veerdonk FL, Jenks JD, Koehler P, Krause R, Cornely OA, S. Perlin D, Lass-Flörl C, Hoenigl M. COVID-19 Associated Pulmonary Aspergillosis (CAPA)-From Immunology to Treatment. J Fungi (Basel) 2020; 6:E91. [PMID: 32599813 PMCID: PMC7346000 DOI: 10.3390/jof6020091] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 01/09/2023] Open
Abstract
Like severe influenza, coronavirus disease-19 (COVID-19) resulting in acute respiratory distress syndrome (ARDS) has emerged as an important disease that predisposes patients to secondary pulmonary aspergillosis, with 35 cases of COVID-19 associated pulmonary aspergillosis (CAPA) published until June 2020. The release of danger-associated molecular patterns during severe COVID-19 results in both pulmonary epithelial damage and inflammatory disease, which are predisposing risk factors for pulmonary aspergillosis. Moreover, collateral effects of host recognition pathways required for the activation of antiviral immunity may, paradoxically, contribute to a highly permissive inflammatory environment that favors fungal pathogenesis. Diagnosis of CAPA remains challenging, mainly because bronchoalveolar lavage fluid galactomannan testing and culture, which represent the most sensitive diagnostic tests for aspergillosis in the ICU, are hindered by the fact that bronchoscopies are rarely performed in COVID-19 patients due to the risk of disease transmission. Similarly, autopsies are rarely performed, which may result in an underestimation of the prevalence of CAPA. Finally, the treatment of CAPA is complicated by drug-drug interactions associated with broad spectrum azoles, renal tropism and damage caused by SARS-CoV-2, which may challenge the use of liposomal amphotericin B, as well as the emergence of azole-resistance. This clinical reality creates an urgency for new antifungal drugs currently in advanced clinical development with more promising pharmacokinetic and pharmacodynamic profiles.
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Affiliation(s)
- Amir Arastehfar
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA;
| | - Agostinho Carvalho
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Braga, Portugal
| | - Frank L. van de Veerdonk
- Department of Internal Medicine, Radboud University Medical Center, 6525 Nijmegen, The Netherlands;
- Radboud Institute of Molecular Life Sciences, Radboud University Medical Center, 6525Nijmegen, The Netherlands
| | - Jeffrey D. Jenks
- Department of Medicine, University of California San Diego, San Diego, CA 92103, USA;
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA 92093, USA
| | - Philipp Koehler
- Department I of Internal Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (P.K.); (O.A.C.)
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50937Cologne, Germany
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Oliver A. Cornely
- Department I of Internal Medicine, Medical Faculty and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany; (P.K.); (O.A.C.)
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, 50937Cologne, Germany
- Zentrum fuer klinische Studien (ZKS) Köln, Clinical Trials Centre Cologne, 50937 Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Medical Faculty and University Hospital Cologne, University of Cologne, 50937 Cologne, Germany
| | - David S. Perlin
- Center for Discovery and Innovation, Hackensack Meridian Health, Nutley, NJ 07110, USA;
| | - Cornelia Lass-Flörl
- Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, 6020 Innsbruck, Austria;
| | - Martin Hoenigl
- Clinical and Translational Fungal-Working Group, University of California San Diego, La Jolla, CA 92093, USA
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria;
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, San Diego, CA 92093, USA
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13
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Šalplachta J, Horká M, Karásek P, Růžička F, Roth M. Identification of Aspergillus Conidia in Bronchoalveolar Lavage Using Offline Combination of Capillary Electrophoresis in Supercritical Water-Treated Fused Silica Capillary and Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry. Anal Chem 2020; 92:7588-7595. [PMID: 32384240 DOI: 10.1021/acs.analchem.0c00165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Diagnosis of fungal infection in lung parenchyma is relatively difficult. Bronchoscopy with bronchoalveolar lavage is very useful in its diagnosing. Therefore, a method for rapid online concentration and analysis of Aspergillus conidia in bronchoalveolar lavage fluid using the combination of transient isotachophoresis (tITP) and micellar electrokinetic chromatography (MEKC) with subsequent off-line identification of the separated conidia by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is described in this study. In the proposed procedure, conidia were first dynamically adhered onto the roughened part of the inner surface of a fused silica capillary prepared by etching with supercritical water. Then the adhered conidia were desorbed, concentrated, and separated using a combination of tITP and MEKC. Finally, the fractions containing the separated conidia were collected from the capillary and analyzed by MALDI-TOF MS. The adhesion efficiency under the optimized experimental conditions was about 80%. This rapid diagnosis will contribute to timely initiation of therapy and increase the patient's chances of survival.
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Affiliation(s)
- Jiří Šalplachta
- Institute of Analytical Chemistry of the CAS, Veveří 97, 602 00 Brno, Czech Republic
| | - Marie Horká
- Institute of Analytical Chemistry of the CAS, Veveří 97, 602 00 Brno, Czech Republic
| | - Pavel Karásek
- Institute of Analytical Chemistry of the CAS, Veveří 97, 602 00 Brno, Czech Republic
| | - Filip Růžička
- Department of Microbiology, Faculty of Medicine, Masaryk University, Kamenice 53/5, 625 00 Brno, Czech Republic
| | - Michal Roth
- Institute of Analytical Chemistry of the CAS, Veveří 97, 602 00 Brno, Czech Republic
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14
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Egger M, Jenks JD, Hoenigl M, Prattes J. Blood Aspergillus PCR: The Good, the Bad, and the Ugly. J Fungi (Basel) 2020; 6:jof6010018. [PMID: 32012787 PMCID: PMC7151127 DOI: 10.3390/jof6010018] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/17/2020] [Accepted: 01/20/2020] [Indexed: 12/11/2022] Open
Abstract
Invasive Aspergillosis (IA) is one of the most common invasive fungal diseases and is accompanied by high morbidity and mortality. In order to maximize patient outcomes and survival, early and rapid diagnosis has been shown to be pivotal. Hence, diagnostic tools aiding and improving the diagnostic process are ambitiously searched for. In this context, polymerase chain reaction (PCR) may represent a potential candidate. Its additional value and benefits in diagnosis have been demonstrated and are scientifically established. Nevertheless, standardized and widespread usage is sparse because several factors influence diagnostic quality and need to be considered in order to optimize diagnostic performance and outcome. In the following review, the current role of PCR in the diagnosis of IA is explored, with special focus on the strengths and limitations of PCR in different settings.
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Affiliation(s)
- Matthias Egger
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, 8036 Graz, Austria; (M.E.); (M.H.)
| | - Jeffrey D. Jenks
- Department of Medicine, University of California San Diego, San Diego, CA 92093, USA;
- Clinical and Translational Fungal Research Group, University of California San Diego, San Diego, CA 92093, USA
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, 8036 Graz, Austria; (M.E.); (M.H.)
- Department of Medicine, University of California San Diego, San Diego, CA 92093, USA;
- Clinical and Translational Fungal Research Group, University of California San Diego, San Diego, CA 92093, USA
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, 8036 Graz, Austria; (M.E.); (M.H.)
- Correspondence: ; Tel.: +43-316-385-30046
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15
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Mikulska M, Furfaro E, De Carolis E, Drago E, Pulzato I, Borghesi ML, Zappulo E, Raiola AM, Grazia CD, Del Bono V, Cittadini G, Angelucci E, Sanguinetti M, Viscoli C. Use of Aspergillus fumigatus real-time PCR in bronchoalveolar lavage samples (BAL) for diagnosis of invasive aspergillosis, including azole-resistant cases, in high risk haematology patients: the need for a combined use with galactomannan. Med Mycol 2020; 57:987-996. [PMID: 30753590 PMCID: PMC7107636 DOI: 10.1093/mmy/myz002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 12/04/2018] [Accepted: 01/26/2019] [Indexed: 12/17/2022] Open
Abstract
Diagnosis of invasive aspergillosis (IA) is challenging, particularly in high-risk patients with lung lesions other than typical according to 2008-EORTC/MSG criteria. Even if microbiology is positive, they still remain unclassified according to 2008-EORTC/MSG. Quantitative polymerase chain reaction (qPCR) provides new mycological documentation of IA. This retrospective study assessed Aspergillus fumigatus real time qPCR (MycoGENIE®) in BAL to diagnose IA and identify azole-resistant strains. Clinical, radiological, and microbiological data from 114 hematology patients (69% HSCT recipients; 29% on mould active agents) from years 2012-2017 were collected; and 123 BAL samples were tested with qPCR (cutoff: Ct < 40) and galactomannan (GM, Platelia®, cutoff: 0.5 ODI). Patients were classified as proven/probable, possible, and no-IA. "Atypical-IA" referred to patients with lesions other than typical according to 2008-EORTC/MSG and positive mycology. Proven IA was diagnosed in two cases (1.6%), probable in 28 (22.8%), possible in 27 (22%), atypical in 14 (11.4%). qPCR was positive in 39 samples (31.7%). Sensitivity and specificity of qPCR for proven/probable IA (vs no-IA; atypical-IA excluded) were 40% (95% confidence interval [CI]: 23–59) and 69% (95%CI: 55–81), respectively. Sensitivity of qPCR was higher when combined with GM (83%, 95%CI: 65–94) and in those receiving mould-active agents at BAL (61%, 95%CI: 32–86). One sample had TR34/L98H mutation. In conclusion, in high-risk hematology patients with various lung lesions, A. fumigatus qPCR in BAL contributes to diagnosing IA, particularly if combined with GM and in patients receiving mould-active agents might allow detecting azole-resistant mutations in culture negative samples.
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Affiliation(s)
- Malgorzata Mikulska
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Elisa Furfaro
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Elena De Carolis
- Institute of Microbiology, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Enrico Drago
- School of Medicine, University of Genoa, Genoa, Italy
| | - Ilaria Pulzato
- Department of Radiology, University of Genoa, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Maria Lucia Borghesi
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Emanuela Zappulo
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy.,Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples "Federico II," Naples, Italy
| | - Anna Maria Raiola
- Division of Hematology and Bone Marrow Transplantation, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Carmen Di Grazia
- Division of Hematology and Bone Marrow Transplantation, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Valerio Del Bono
- Infectious Diseases Unit, Azienda Ospedaliera S. Croce e Carle, Cuneo, Italy
| | - Giuseppe Cittadini
- Department of Radiology, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Emanuele Angelucci
- Division of Hematology and Bone Marrow Transplantation, Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
| | - Maurizio Sanguinetti
- Institute of Microbiology, Università Cattolica del Sacro Cuore - Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - Claudio Viscoli
- Division of Infectious Diseases, Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.,Ospedale Policlinico San Martino-IRCCS per l'Oncologia, Genoa, Italy
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16
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Immune Parameters for Diagnosis and Treatment Monitoring in Invasive Mold Infection. J Fungi (Basel) 2019; 5:jof5040116. [PMID: 31888227 PMCID: PMC6958498 DOI: 10.3390/jof5040116] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/12/2019] [Accepted: 12/13/2019] [Indexed: 12/13/2022] Open
Abstract
Infections caused by invasive molds, including Aspergillus spp., can be difficult to diagnose and remain associated with high morbidity and mortality. Thus, early diagnosis and targeted systemic antifungal treatment remains the most important predictive factor for a successful outcome in immunocompromised individuals with invasive mold infections. Diagnosis remains difficult due to low sensitivities of diagnostic tests including culture and other mycological tests for mold pathogens, particularly in patients on mold-active antifungal prophylaxis. As a result, antifungal treatment is rarely targeted and reliable markers for treatment monitoring and outcome prediction are missing. Thus, there is a need for improved markers to diagnose invasive mold infections, monitor response to treatment, and assist in determining when antifungal therapy should be escalated, switched, or can be stopped. This review focuses on the role of immunologic markers and specifically cytokines in diagnosis and treatment monitoring of invasive mold infections.
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17
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Diagnostic Performance and Safety of Bronchoalveolar Lavage in Thrombocytopenic Haematological Patients for Invasive Fungal Infections Diagnosis: A Monocentric, Retrospective Experience. Mediterr J Hematol Infect Dis 2019; 11:e2019065. [PMID: 31700590 PMCID: PMC6827601 DOI: 10.4084/mjhid.2019.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/14/2019] [Indexed: 01/11/2023] Open
Abstract
Background Although bronchoalveolar lavage (BAL) measurements of galactomannan antigen (GM) seems to be more sensitive than serum testing to detect invasive fungal infection (IFI), a consensus on the most appropriate diagnostic threshold of the BAL GM test is still unclear. Moreover, there is uncertainty as to whether BAL is a safe procedure in patients with hematological malignancies (HM) and thrombocytopenia. Objectives Based on this background, 102 adult patients with HM and associated thrombocytopenia were retrospectively analyzed with the dual aim of 1) determining whether BAL is a safe and feasible procedure; and, 2) identifying the most appropriate threshold for GM positivity in the diagnosis of IFI. Patients/Methods each BAL was considered as one case/patient. One hundred twelve BALs were carried out in 102 HM patients: at the time of the BAL, the median platelet count (PLTs) in all patients was 47×109/L (1–476), and 31 patients (27%) had PLTs< 20×109/L. Results complications from the BAL were infrequent (3.5%) and mild. No bleeding was reported. The BAL GM cut off of >0.8 was associated with the best diagnostic accuracy (sensitivity 72.97% and specificity 80%). Antifungal treatment of patients with BAL GM >0.8 resulted in a clinical-radiological improvement in 35/41 patients (85%). Conclusions BAL was a safe procedure also in thrombocytopenic patients, permitting an IFI diagnosis not otherwise identifiable using EORTC/MSG criteria. Our data suggest that a BAL GM value of>0.8 represents the most useful cut-off in terms of sensibility and specificity. Further prospective studies on a more significant number of patients are needed to confirm these results.
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18
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Jenks JD, Spiess B, Buchheidt D, Hoenigl M. (New) Methods for Detection of Aspergillus fumigatus Resistance in Clinical Samples. CURRENT FUNGAL INFECTION REPORTS 2019; 13:129-136. [PMID: 31552129 PMCID: PMC6759225 DOI: 10.1007/s12281-019-00342-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW The incidence of invasive aspergillosis has increased substantially over the past few decades, accompanied by a change in susceptibility patterns of Aspergillus fumigatus with increasing resistance observed against triazole antifungals, including voriconazole and isavuconazole, the most commonly used antifungal agents for the disease. Culture-based methods for determining triazole resistance are still the gold standard but are time consuming and lack sensitivity. We sought to provide an update on non-culture-based methods for detecting resistance patterns to Aspergillus. RECENT FINDINGS New molecular-based approaches for detecting triazole resistance to Aspergillus, real-time polymerase chain reaction (PCR) to detect mutations to the Cyp51A protein, have been developed which are able to detect most triazole-resistant A. fumigatus strains in patients with invasive aspergillosis. SUMMARY Over the last few years, a number of non-culture-based methods for molecular detection of Aspergillus triazole resistance have been developed that may overcome some of the limitations of culture. These molecular methods are therefore of high epidemiological and clinical relevance, mainly in immunocompromised patients with hematological malignancies, where culture has particularly limited sensitivity. These assays are now able to detect most triazole-resistant Aspergillus fumigatus strains. Given that resistance rates vary, clinical utility for these assays still depends on regional resistance patterns.
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Affiliation(s)
- Jeffrey D. Jenks
- Department of Medicine, University of California San Diego, San Diego, CA 92103, USA
| | - Birgit Spiess
- Department of Hematology and Oncology, Scientific Laboratory, University Hospital Mannheim, Heidelberg University, Pettenkoferstraße 22, 68169 Mannheim, Germany
| | - Dieter Buchheidt
- Department of Hematology and Oncology, Scientific Laboratory, University Hospital Mannheim, Heidelberg University, Pettenkoferstraße 22, 68169 Mannheim, Germany
| | - Martin Hoenigl
- Department of Medicine, University of California San Diego, San Diego, CA 92103, USA
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
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19
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Salzer HJF, Prattes J, Hoenigl M. Editorial: Diagnostic Approaches for Aspergillus Infections. Front Microbiol 2019; 10:446. [PMID: 30941107 PMCID: PMC6434925 DOI: 10.3389/fmicb.2019.00446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/20/2019] [Indexed: 11/25/2022] Open
Affiliation(s)
- Helmut J F Salzer
- Department of Pulmonary Medicine, Kepler University Hospital, Linz, Austria.,Institute of Nuclear Medicine and Endocrinology, Kepler University Hospital, Linz, Austria
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,Division of Infectious Diseases, Department of Medicine, University of California, San Diego, San Diego, CA, United States
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20
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Krifors A, Özenci V, Ullberg M, Ackefors M, Jädersten M, Strålin K, Blennow O. PCR with electrospray ionization-mass spectrometry on bronchoalveolar lavage for detection of invasive mold infections in hematological patients. PLoS One 2019; 14:e0212812. [PMID: 30794675 PMCID: PMC6386253 DOI: 10.1371/journal.pone.0212812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 02/08/2019] [Indexed: 02/04/2023] Open
Abstract
Invasive mold infections are life-threatening complications in patients with hematological malignancies. Conventional microbiological methods for diagnosing invasive pulmonary mold infections have low sensitivity, and molecular methods are being developed. Detection of molds using PCR with a narrow spectrum has been reported, but data with broad-spectrum PCR are lacking. In this study, the diagnostic performance and utility of a broad-spectrum PCR (broad-spectrum PCR with subsequent electrospray ionization-mass spectrometry, PCR/ESI-MS) for detection of molds in bronchoalveolar lavage (BAL) in 27 hematological patients with a new pulmonary infiltrate was analyzed. Using the revised EORTC/MSG criteria, PCR/ESI-MS was the only positive microbiological test in patients with proven invasive mold infection (n = 2) and correctly identified all cases of probable invasive pulmonary aspergillosis (n = 5). In patients with a possible invasive mold infection (n = 5), PCR/ESI-MS was positive in three patients. Mucorales was identified with PCR/ESI-MS in four patients that were all culture negative. The PCR/ESI-MS results had a clinical impact on antifungal therapy in 12 (44%) of the patients: modification of treatment in 6 (22%) patients and discontinuation in 6 (22%) patients. This study provides proof of concept that routine use of a broad-spectrum PCR for molds in bronchoalveolar lavage in immunocompromised patients is sensitive, fast, and has an impact on clinical decision-making.
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Affiliation(s)
- Anders Krifors
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Volkan Özenci
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Måns Ullberg
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Malin Ackefors
- Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
| | - Martin Jädersten
- Centre for Haematology and Regenerative Medicine, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Kristoffer Strålin
- Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Ola Blennow
- Department of Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
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21
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Hoenigl M, Orasch T, Faserl K, Prattes J, Loeffler J, Springer J, Gsaller F, Reischies F, Duettmann W, Raggam RB, Lindner H, Haas H. Triacetylfusarinine C: A urine biomarker for diagnosis of invasive aspergillosis. J Infect 2019; 78:150-157. [PMID: 30267801 PMCID: PMC6361682 DOI: 10.1016/j.jinf.2018.09.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 08/20/2018] [Accepted: 09/11/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Early diagnosis of invasive aspergillosis (IA) remains challenging, with available diagnostics being limited by inadequate sensitivities and specificities. Triacetylfusarinine C, a fungal siderophore that has been shown to accumulate in urine in animal models, is a potential new biomarker for diagnosis of IA. METHODS We developed a method allowing absolute and matrix-independent mass spectrometric quantification of TAFC. Urine TAFC, normalized to creatinine, was determined in 44 samples from 24 patients with underlying hematologic malignancies and probable, possible or no IA according to current EORTC/MSG criteria and compared to other established biomarkers measured in urine and same-day blood samples. RESULTS TAFC/creatinine sensitivity, specificity, positive and negative likelihood ratio for probable versus no IA (cut-off ≥ 3) were 0.86, 0.88, 6.86, 0.16 per patient. CONCLUSION For the first time, we provide proof for the occurrence of TAFC in human urine. TAFC/creatinine index determination in urine showed promising results for diagnosis of IA offering the advantages of non-invasive sampling. Sensitivity and specificity were similar as reported for GM determination in serum and bronchoalveolar lavage, the gold standard mycological criterion for IA diagnosis.
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Affiliation(s)
- Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria; CBmed Center for Biomarker Research in Medicine, Graz, Austria; Division of Infectious Diseases, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Thomas Orasch
- Division of Molecular Biology, Medical University of Innsbruck, Innrain 80/82, 6020 Innsbruck, Austria
| | - Klaus Faserl
- Division of Clinical Biochemistry, Medical University of Innsbruck, Innrain 80/82, 6020 Innsbruck, Austria
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria; CBmed Center for Biomarker Research in Medicine, Graz, Austria
| | - Juergen Loeffler
- Department for Internal Medicine II, University of Wuerzburg Medical Centre, Wuerzburg, Germany
| | - Jan Springer
- Department for Internal Medicine II, University of Wuerzburg Medical Centre, Wuerzburg, Germany
| | - Fabio Gsaller
- Division of Molecular Biology, Medical University of Innsbruck, Innrain 80/82, 6020 Innsbruck, Austria
| | - Frederike Reischies
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Wiebke Duettmann
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Reinhard B Raggam
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria; Division of Angiology, Medical University of Graz, Graz, Austria
| | - Herbert Lindner
- Division of Clinical Biochemistry, Medical University of Innsbruck, Innrain 80/82, 6020 Innsbruck, Austria.
| | - Hubertus Haas
- Division of Molecular Biology, Medical University of Innsbruck, Innrain 80/82, 6020 Innsbruck, Austria.
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22
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Jenks JD, Mehta SR, Taplitz R, Aslam S, Reed SL, Hoenigl M. Point-of-care diagnosis of invasive aspergillosis in non-neutropenic patients: Aspergillus Galactomannan Lateral Flow Assay versus Aspergillus-specific Lateral Flow Device test in bronchoalveolar lavage. Mycoses 2019; 62:230-236. [PMID: 30565352 DOI: 10.1111/myc.12881] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 11/30/2018] [Accepted: 12/09/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND We compared new Aspergillus Galactomannan Lateral Flow Assay with the newly formatted Aspergillus-specific Lateral Flow device tests for the diagnosis of invasive pulmonary aspergillosis (IPA) in non-neutropenic patients. METHODS We performed both tests in 82 bronchoalveolar lavage fluid samples from 82 patients at risk for IPA but without underlying haematologic malignancy. Samples were collected between September 2016 and September 2018 at the University of California San Diego, United States. IPA was classified following two published consensus criteria. RESULTS Classification of cases varied widely between the two consensus criteria. When using criteria established for the intensive care unit, 26/82 patients (32%) met criteria for proven or putative IPA. Both point-of-care assays showed sensitivities ranging between 58% and 69%, with specificities between 68% and 75%. Sensitivity increased up to 81% when both tests were combined. CONCLUSION The study outlines the need for updated, unified and more broadly applicable consensus definitions for classifying IPA in non-neutropenic patients, a work that is currently in progress. Both point-of-care tests showed comparable performance, with sensitivities and specificities in the 60%-70% range when used alone and increasing to 80% when used in combination. The new point-of-care tests may serve a role at the bedside in those with clinical suspicion of IPA.
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Affiliation(s)
- Jeffrey D Jenks
- Department of Medicine, University of California San Diego, San Diego, California
| | - Sanjay R Mehta
- Department of Medicine, University of California San Diego, San Diego, California
| | - Randy Taplitz
- Department of Medicine, University of California San Diego, San Diego, California
| | - Saima Aslam
- Department of Medicine, University of California San Diego, San Diego, California
| | - Sharon L Reed
- Department of Medicine, University of California San Diego, San Diego, California.,Department of Pathology, University of California San Diego, San Diego, California
| | - Martin Hoenigl
- Department of Medicine, University of California San Diego, San Diego, California
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23
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Abstract
Fungi of the genus Aspergillus are ubiquitously present. Even though humans inhale Aspergillus spores daily under natural conditions, Aspergillus-associated pulmonary diseases only occur under special circumstances. Whether an Aspergillus-associated disease develops and which type of Aspergillus-associated disease develops depends on the constitution of the host. The spectrum of Aspergillus-associated pulmonary diseases ranges from allergic diseases, such as hypersensitivity pneumonitis to allergic infectious diseases, such as allergic bronchopulmonary aspergillosis (ABPA) and bronchocentric granulomatosis (BG) to infectious diseases, such as invasive (IA) or semi-invasive aspergillosis (SIA) and chronic pulmonary aspergillosis (CPA). Identification of Aspergillus spp. from sputum or bronchopulmonary secretions is not sufficient for a definitive diagnosis of Aspergillus-associated infections. The gold standard is the identification of Aspergillus spp. from lung tissue by culture or by histopathological methods; however, in clinical practice the decision to initiate antifungal therapy is more often based on immunological methods, such as the detection of Aspergillus-specific IgG antibodies from peripheral blood or galactomannan antigens from bronchoalveolar lavages. Acute IA or SIA infections have a high mortality and require immediate antifungal therapy. With rare exceptions CPA cannot be cured by medicinal therapy alone; however, active CPA can be brought into remission with antifungal therapy. Eradication of Aspergillus in CPA can as a rule only be successful using a combined antimycotic and surgical intervention.
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Affiliation(s)
- H J F Salzer
- Klinische Infektiologie, Medizinische Klinik, Forschungszentrum Borstel, Leibniz-Zentrum für Medizin und Biowissenschaften, Parkallee 35, 23845, Borstel, Deutschland.
- Hamburg - Borstel - Lübeck - Riems DZIF-Standort, Deutsches Zentrum für Infektionsforschung (DZIF), Borstel, Deutschland.
| | - C Lange
- Klinische Infektiologie, Medizinische Klinik, Forschungszentrum Borstel, Leibniz-Zentrum für Medizin und Biowissenschaften, Parkallee 35, 23845, Borstel, Deutschland
- Hamburg - Borstel - Lübeck - Riems DZIF-Standort, Deutsches Zentrum für Infektionsforschung (DZIF), Borstel, Deutschland
- International Health and Infectious Diseases, Universität zu Lübeck, Lübeck, Deutschland
- Department of Medicine, Karolinska Institute, Stockholm, Schweden
| | - M Hönigl
- Klinische Abteilung für Pulmonologie, Medizinische Universität Graz, Graz, Österreich
- Sektion für Infektionserkrankungen und Tropenmedizin, Medizinische Universität Graz, Graz, Österreich
- Division of Infectious Diseases, Department of Medicine, University of California - San Diego, San Diego, USA
- CBmed - Center for Biomarker Research in Medicine, Graz, Österreich
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24
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de Groot T, Hagen F, Vreuls W, Verweij PE, Chowdhary A, Meis JF. Genotyping of Aspergillus fumigatus in Formalin-Fixed Paraffin-Embedded Tissues and Serum Samples From Patients With Invasive Aspergillosis. Front Cell Infect Microbiol 2018; 8:377. [PMID: 30406050 PMCID: PMC6206585 DOI: 10.3389/fcimb.2018.00377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 10/05/2018] [Indexed: 12/15/2022] Open
Abstract
Invasive aspergillosis (IA) is a deep tissue infection with a high mortality occurring mostly in immunocompromised patients. To investigate the pathology of patients with IA it may be important to determine the genotype of the invasive isolate of Aspergillus, however available tissues for study are often formalin fixed paraffin embedded (FFPE). Although DNA has been successfully isolated from such tissues for species identification, genotyping of Aspergillus species on such tissues has not yet been performed. In this study we aimed to determine the genotype of Aspergillus fumigatus in FFPE tissue and serum samples from five patients with invasive aspergillosis using nine highly polymorphic short tandem repeat (STRAf) loci. FFPE lung and bronchial biopsies from all patients were successfully typed. By comparing the latter result with non-FFPE materials from non-sterile samples such as sputum, bronchoalveolar lavage and lung abscess, we found identical genotypes within three patients, while the two other patients had a dominant genotype shared among all sample types. Genotyping of serum samples was successful in two serum samples with galactomannan ratios of 4 and 5.6, but failed in serum samples with galactomannan levels <0.5. In addition, testing a subset of these materials with the AsperGenius multiplex qPCR assay, we did not find azole resistance mutations. With this STRAf assay, A. fumigatus from FFPE tissue and serum was successfully genotyped, allowing retrospective examination of A. fumigatus in culture negative patients with IA.
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Affiliation(s)
- Theun de Groot
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Ferry Hagen
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, Netherlands.,Department of Medical Mycology, Westerdijk Fungal Biodiversity Institute, Utrecht, Netherlands
| | - Willem Vreuls
- Department of Clinical Pathology, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Paul E Verweij
- Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, Netherlands.,Department of Medical Microbiology, Radboudumc, Nijmegen1, Netherlands
| | - Anuradha Chowdhary
- Department of Medical Mycology, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, India
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, Netherlands.,Centre of Expertise in Mycology Radboudumc/CWZ, Nijmegen, Netherlands.,Department of Medical Microbiology, Radboudumc, Nijmegen1, Netherlands
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25
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Salzer HJF, Prattes J, Flick H, Reimann M, Heyckendorf J, Kalsdorf B, Obersteiner S, Gaede KI, Herzmann C, Johnson GL, Lange C, Hoenigl M. Evaluation of Galactomannan Testing, the Aspergillus-Specific Lateral-Flow Device Test and Levels of Cytokines in Bronchoalveolar Lavage Fluid for Diagnosis of Chronic Pulmonary Aspergillosis. Front Microbiol 2018; 9:2223. [PMID: 30333797 PMCID: PMC6176022 DOI: 10.3389/fmicb.2018.02223] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 08/31/2018] [Indexed: 12/29/2022] Open
Abstract
Background: Diagnosis of chronic pulmonary aspergillosis (CPA) is challenging. Symptoms are unspecific or missing, radiological findings are variable and proof of mycological evidence is limited by the accuracy of diagnostic tests. The goal of this study was to investigate diagnostic performance of galactomannan (GM), the newly formatted Aspergillus-specific lateral-flow-device test (LFD), and a number of cytokines in bronchoalveolar lavage fluid (BALF) samples obtained from patients with CPA, patients with respiratory disorders without CPA and healthy individuals. Methods: Patients with CPA (n = 27) and controls (n = 27 with underlying respiratory diseases but without CPA, and n = 27 healthy volunteers) were recruited at the Medical University of Graz, Austria and the Research Center Borstel, Germany between 2010 and 2018. GM, LFD and cytokine testing was performed retrospectively at the Research Center Borstel. Results: Sensitivity and specificity of GM testing from BALF with a cut off level of ≥0.5 optical density index (ODI) was 41 and 100% and 30 and 100% with a cut off level of ≥1.0 ODI. ROC curve analysis showed an AUC 0.718 (95% CI 0.581–0.855) for GM for differentiating CPA patients to patients with other respiratory diseases without CPA. The LFD resulted positive in only three patients with CPA (7%) and was highly specific. CPA patients did not differ significantly in the BALF cytokine profile compared to patients with respiratory disorders without CPA, but showed significant higher values for IFN-γ, IL-1b, IL-6, IL-8, and TNF-α compared to healthy individuals. Conclusion: Both GM and LFD showed insufficient performance for diagnosing CPA, with sensitivities of BALF GM below 50%, and sensitivity of the LFD below 10%. The high specificities may, however, result in a high positive predictive value and thereby help to identify semi-invasive or invasive disease.
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Affiliation(s)
- Helmut J F Salzer
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Borstel, Germany
| | - Juergen Prattes
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Borstel, Germany.,Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Holger Flick
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Borstel, Germany.,Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria
| | - Maja Reimann
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Borstel, Germany
| | - Jan Heyckendorf
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Borstel, Germany
| | - Barbara Kalsdorf
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Borstel, Germany
| | - Sabrina Obersteiner
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Borstel, Germany.,Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,CBmed - Center for Biomarker Research in Medicine, Graz, Austria
| | - Karoline I Gaede
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Borstel, Germany.,BioMaterialBank North, Research Center Borstel, Leibniz Center for Medicine and Biosciences, Borstel, Germany.,Airway Research Center North, Member of the German Center for Lung Research, Borstel, Germany
| | - Christian Herzmann
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Borstel, Germany.,Center for Clinical Studies, Research Center Borstel, Borstel, Germany.,German Center for Infection Research, Clinical Trials Unit, Borstel, Germany
| | - Gemma L Johnson
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Borstel, Germany.,OLM Diagnostics, Newcastle upon Tyne, United Kingdom
| | - Christoph Lange
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Borstel, Germany.,International Health/Infectious Diseases, University of Lübeck, Lübeck, Germany.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Martin Hoenigl
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel, Borstel, Germany.,Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Austria.,Division of Infectious Diseases, Department of Medicine, University of California, San Diego, San Diego, CA, United States
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26
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Jenks JD, Hoenigl M. Treatment of Aspergillosis. J Fungi (Basel) 2018; 4:jof4030098. [PMID: 30126229 PMCID: PMC6162797 DOI: 10.3390/jof4030098] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/12/2018] [Accepted: 08/15/2018] [Indexed: 02/07/2023] Open
Abstract
Infections caused by Aspergillus spp. remain associated with high morbidity and mortality. While mold-active antifungal prophylaxis has led to a decrease of occurrence of invasive aspergillosis (IA) in those patients most at risk for infection, breakthrough IA does occur and remains difficult to diagnose due to low sensitivities of mycological tests for IA. IA is also increasingly observed in other non-neutropenic patient groups, where clinical presentation is atypical and diagnosis remains challenging. Early and targeted systemic antifungal treatment remains the most important predictive factor for a successful outcome in immunocompromised individuals. Recent guidelines recommend voriconazole and/or isavuconazole for the primary treatment of IA, with liposomal amphotericin B being the first alternative, and posaconazole, as well as echinocandins, primarily recommended for salvage treatment. Few studies have evaluated treatment options for chronic pulmonary aspergillosis (CPA), where long-term oral itraconazole or voriconazole remain the treatment of choice.
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Affiliation(s)
- Jeffrey D Jenks
- Department of Medicine, University of California⁻San Diego, San Diego, CA 92103, USA.
| | - Martin Hoenigl
- Division of Infectious Diseases, Department of Medicine, University of California⁻San Diego, San Diego, CA 92103, USA.
- Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz 8036, Austria.
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27
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Jenks JD, Reed SL, Seidel D, Koehler P, Cornely OA, Mehta SR, Hoenigl M. Rare mould infections caused by Mucorales, Lomentospora prolificans and Fusarium, in San Diego, CA: the role of antifungal combination therapy. Int J Antimicrob Agents 2018; 52:706-712. [PMID: 30099056 DOI: 10.1016/j.ijantimicag.2018.08.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/29/2018] [Accepted: 08/04/2018] [Indexed: 12/31/2022]
Abstract
Non-Aspergillus invasive mould infections (IMIs) are associated with devastating morbidity and mortality rates and are increasingly diagnosed in immunocompromised hosts. The aim of this study was to describe the epidemiology and outcomes of non-Aspergillus IMIs at a university hospital in San Diego, California, USA. A retrospective chart review of the medical records of all patients with cultures growing non-Aspergillus moulds at the microbiology laboratory in the Center for Academic Laboratory Medicine, Department of Pathology, University of California, San Diego (UCSD) Health between mid-2014 and mid-2017 (3-year period) was performed. A total of 23 cases of non-Aspergillus IMI were identified, including 10 cases of mucormycosis, 8 cases of lomentosporiosis and 5 cases of fusariosis. Antifungal susceptibility testing was performed for 14 isolates, and 10/11 Fusarium and Lomentospora isolates had minimum inhibitory concentrations (MICs) of >16 µg/mL for voriconazole and/or posaconazole. Overall 180-day mortality was significantly lower among those who received combination antifungal therapy than among those who received single-agent therapy [3/13 (23%) vs. 9/10 (90%); P = 0.003]. In conclusion, Lomentospora prolificans (35% of non-Aspergillus IMIs) and Fusarium spp. (22%) accounted for high proportions of non-Aspergillus IMIs during the study period. Non-Aspergillus IMIs were detected in patients with various underlying diseases and were associated with high mortality rates, which was significantly lower in those who received antifungal combination therapy.
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Affiliation(s)
- Jeffrey D Jenks
- Department of Medicine, University of California, San Diego, San Diego, CA, USA.
| | - Sharon L Reed
- Department of Medicine, University of California, San Diego, San Diego, CA, USA; Department of Pathology, University of California, San Diego, San Diego, CA, USA
| | - Danila Seidel
- Department of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University Hospital Cologne, and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Philipp Koehler
- Department of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University Hospital Cologne, and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Oliver A Cornely
- Department of Internal Medicine, Excellence Center for Medical Mycology (ECMM), University Hospital Cologne, and Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany
| | - Sanjay R Mehta
- Department of Medicine, University of California, San Diego, San Diego, CA, USA
| | - Martin Hoenigl
- Department of Medicine, University of California, San Diego, San Diego, CA, USA; Department of Medicine, Medical University of Graz, Graz, Austria.
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28
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Heldt S, Prattes J, Eigl S, Spiess B, Flick H, Rabensteiner J, Johnson G, Prüller F, Wölfler A, Niedrist T, Boch T, Neumeister P, Strohmaier H, Krause R, Buchheidt D, Hoenigl M. Diagnosis of invasive aspergillosis in hematological malignancy patients: Performance of cytokines, Asp LFD, and Aspergillus PCR in same day blood and bronchoalveolar lavage samples. J Infect 2018; 77:235-241. [PMID: 29972764 DOI: 10.1016/j.jinf.2018.05.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Aspergillus spp. induce elevated levels of several cytokines. It remains unknown whether these cytokines hold value for clinical routine and enhance diagnostic performances of established and novel biomarkers/tests for invasive aspergillosis (IA). METHODS This cohort study included 106 prospectively enrolled (2014-2017) adult cases with underlying hematological malignancies and suspected pulmonary infection undergoing bronchoscopy. Serum samples were collected within 24 hours of bronchoalveolar lavage fluid (BALF) sampling. Both, serum and BALF samples were used to evaluate diagnostic performances of the Aspergillus-specific lateral-flow device test (LFD), Aspergillus PCR, β-D-glucan, and cytokines that have shown significant associations with IA before. RESULTS Among 106 cases, 11 had probable IA, and 32 possible IA; 80% received mold-active antifungals at the time of sampling. Diagnostic tests and biomarkers showed better performance in BALF versus blood, with the exception of serum interleukin (IL)-8 which was the most reliable blood biomarker. Combinations of serum IL-8 with either BALF LFD (sensitivity 100%, specificity 94%) or BALF PCR (sensitivity 91%, specificity 97%) showed promise for differentiating probable IA from no IA. CONCLUSIONS High serum IL-8 levels were highly specific, and when combined with either the BALF Aspergillus-specific LFD, or BALF Aspergillus PCR also highly sensitive for diagnosis of IA.
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Affiliation(s)
- Sven Heldt
- Division of Pulmonology, Medical University of Graz, Graz, Austria; Section of Infectious Diseases and Tropical Medicine, Department of Medicine, Medical University of Graz, 8036 Graz, Austria
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Department of Medicine, Medical University of Graz, 8036 Graz, Austria; CBmed - Center for Biomarker Research in Medicine, Graz, Austria
| | - Susanne Eigl
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Birgit Spiess
- Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Holger Flick
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Jasmin Rabensteiner
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Gemma Johnson
- OLM Diagnostics, Newcastle-upon-Tyne, United Kingdom
| | - Florian Prüller
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Albert Wölfler
- CBmed - Center for Biomarker Research in Medicine, Graz, Austria; Division of Hematology, Medical University of Graz, Graz, Austria
| | - Tobias Niedrist
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
| | - Tobias Boch
- Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Peter Neumeister
- Division of Hematology, Medical University of Graz, Graz, Austria
| | - Heimo Strohmaier
- Center for Medical Research, Medical University of Graz, Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Medicine, Medical University of Graz, 8036 Graz, Austria; CBmed - Center for Biomarker Research in Medicine, Graz, Austria
| | - Dieter Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Martin Hoenigl
- Division of Pulmonology, Medical University of Graz, Graz, Austria; Section of Infectious Diseases and Tropical Medicine, Department of Medicine, Medical University of Graz, 8036 Graz, Austria; CBmed - Center for Biomarker Research in Medicine, Graz, Austria; Division of Infectious Diseases, Department of Medicine, University of California San Diego, San Diego, CA 92103, USA.
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29
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Jenks JD, Salzer HJ, Prattes J, Krause R, Buchheidt D, Hoenigl M. Spotlight on isavuconazole in the treatment of invasive aspergillosis and mucormycosis: design, development, and place in therapy. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:1033-1044. [PMID: 29750016 PMCID: PMC5933337 DOI: 10.2147/dddt.s145545] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
In recent decades, important advances have been made in the diagnosis and treatment of invasive aspergillosis (IA) and mucormycosis. One of these advances has been the introduction of isavuconazole, a second-generation broad spectrum triazole with a favorable pharmacokinetic and safety profile and few drug–drug interactions. Phase III trials in patients with IA and mucormycosis demonstrated that isavuconazole has similar efficacy to voriconazole for the treatment of IA (SECURE trial) and liposomal amphotericin B for the treatment of mucormycosis (VITAL trial with subsequent case–control analysis) and a favorable safety profile with significantly fewer ocular, hepatobiliary, and skin and soft tissue adverse events compared to voriconazole. As a result, recent IA guidelines recommend isavuconazole (together with voriconazole) as gold standard treatment for IA in patients with underlying hematological malignancies. In contrast to liposomal amphotericin B, isavuconazole can be safely administered in patients with reduced renal function and is frequently used for the treatment of mucormycosis in patients with reduced renal function. Updated guidelines on mucormycosis are needed to reflect the current evidence and give guidance on the use of isavuconazole for mucormycosis. Studies are needed to evaluate the role of isavuconazole for 1) anti-mold prophylaxis in high-risk patients, 2) salvage treatment for IA and mucormycosis, and 3) treatment for other mold infections such as Scedosporium apiospermum.
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Affiliation(s)
- Jeffrey D Jenks
- Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Helmut Jf Salzer
- Division of Clinical Infectious Diseases, Research Center Borstel, Borstel, Germany.,German Center for Infection Research, Clinical Tuberculosis Center, Leibniz Lung Center, Borstel, Germany
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,CBmed - Center for Biomarker Research in Medicine, Graz, Austria
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria.,CBmed - Center for Biomarker Research in Medicine, Graz, Austria
| | - Dieter Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, Heidelberg University, Mannheim, Germany
| | - Martin Hoenigl
- Department of Medicine, University of California San Diego, San Diego, CA, USA.,German Center for Infection Research, Clinical Tuberculosis Center, Leibniz Lung Center, Borstel, Germany.,Division of Pulmonology, Medical University of Graz, Graz, Austria.,Division of Infectious Diseases, Department of Medicine, University of California San Diego, San Diego, CA, USA
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Denis J, Forouzanfar F, Herbrecht R, Toussaint E, Kessler R, Sabou M, Candolfi E, Letsher-Bru V. Evaluation of Two Commercial Real-Time PCR Kits for Aspergillus DNA Detection in Bronchoalveolar Lavage Fluid in Patients with Invasive Pulmonary Aspergillosis. J Mol Diagn 2018; 20:298-306. [PMID: 29471112 PMCID: PMC7185652 DOI: 10.1016/j.jmoldx.2017.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 12/21/2017] [Accepted: 12/22/2018] [Indexed: 02/07/2023] Open
Abstract
Invasive pulmonary aspergillosis (IPA) is a common complication of immunosuppression. Rapid diagnosis using molecular techniques is essential to improve patient survival. PCR techniques are promising in enhancing Aspergillus detection in blood and respiratory samples. We evaluate for the first time the performances of two commercial real-time PCR kits, the A. fumigatus Bio-Evolution and the MycoGENIE A. fumigatus for the detection of A. fumigatus DNA in bronchoalveolar lavage (BAL) from patients with and without IPA. Seventy-three BAL samples were included. Thirty-one of them corresponded to patients with probable IPA, 11 to patients with possible IPA, and 31 to patients without aspergillosis, according to the 2008 European Organization for Research and Treatment of Cancer/Mycoses Study Group criteria. In the probable IPA group, A. fumigatus Bio-Evolution and the MycoGENIE A. fumigatus real-time PCR kits showed a specificity of 100% and a sensitivity of 81% and 71%, respectively. The A. fumigatus Bio-Evolution detected Aspergillus DNA in the 14 BAL samples with a positive Aspergillus culture result, whereas the MycoGENIE A. fumigatus PCR result was positive only for 12. In the possible IPA group, there were no positive real-time PCR or positive Aspergillus culture results. For the patients without aspergillosis, no positive result was observed for real-time PCR kit, despite the presence of various other non-Aspergillus pathogens in this group. Our study demonstrates an excellent specificity and a good sensitivity of A. fumigatus DNA detection in BAL samples with both kits.
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Affiliation(s)
- Julie Denis
- Laboratoire de Parasitologie et de Mycologie Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
| | - Faezeh Forouzanfar
- Laboratoire de Parasitologie et de Mycologie Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France; Institut de Parasitologie et de Pathologie Tropicale, Fédération de Médecine Translationnelle, Université de Strasbourg, Strasbourg, France
| | - Raoul Herbrecht
- Service d'Oncologie et d'Hématologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg & Université de Strasbourg, Strasbourg, France
| | - Elise Toussaint
- Service d'Oncologie et d'Hématologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg & Université de Strasbourg, Strasbourg, France
| | - Romain Kessler
- Pôle Pathologie thoracique, CHU de Strasbourg, Strasbourg, France
| | - Marcela Sabou
- Laboratoire de Parasitologie et de Mycologie Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Ermanno Candolfi
- Laboratoire de Parasitologie et de Mycologie Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Valérie Letsher-Bru
- Laboratoire de Parasitologie et de Mycologie Médicale, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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McCarthy MW, Petraitiene R, Walsh TJ. Nucleic acid amplification methodologies for the detection of pulmonary mold infections. Expert Rev Mol Diagn 2017; 17:271-279. [PMID: 28218019 DOI: 10.1080/14737159.2017.1293528] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The detection of pulmonary mold infections has historically required technically demanding methods obtained through invasive procedures. Nucleic acid amplification assays have the potential to circumvent the technical hurdles associated with diagnosis, but are not without potential pitfalls. Areas covered: In this paper, the authors review new assays for the diagnosis of pulmonary mold infections due to aspergillosis, mucormycosis, and hyalohyphomycoses as well as uncommon infections caused by dematiaceous molds. Expert commentary: Nucleic acid amplification assays have the potential to rapidly identify patients with invasive mycoses and could shorten the time to implementation of appropriate antimicrobial therapy. However, selection of appropriate patient populations will be crucial to ensure the highest Bayesian positive predictive value for any novel diagnostic platform.
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Affiliation(s)
- Matthew William McCarthy
- a Department of Medicine , Joan and Sanford I Weill Medical College of Cornell University - Hospital Medicine , New York , NY , USA
| | - Ruta Petraitiene
- b Department of Medicine , Cornell University , NY , New York City , USA
| | - Thomas J Walsh
- c Department of Medicine , Weill Cornell Medical Center - Transplantation, Oncology Infectious Diseases Program , New York , NY , USA
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Orasch T, Prattes J, Faserl K, Eigl S, Düttmann W, Lindner H, Haas H, Hoenigl M. Bronchoalveolar lavage triacetylfusarinine C (TAFC) determination for diagnosis of invasive pulmonary aspergillosis in patients with hematological malignancies. J Infect 2017; 75:370-373. [PMID: 28576596 DOI: 10.1016/j.jinf.2017.05.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 05/22/2017] [Accepted: 05/24/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Thomas Orasch
- Division of Molecular Biology, Innsbruck Medical University, Innsbruck, Austria
| | - Juergen Prattes
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria; CBmed Center for Biomarker Research in Medicine, Graz, Austria
| | - Klaus Faserl
- Division of Clinical Biochemistry, Innsbruck Medical University, Innsbruck, Austria
| | - Susanne Eigl
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Wiebke Düttmann
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - Herbert Lindner
- Division of Clinical Biochemistry, Innsbruck Medical University, Innsbruck, Austria
| | - Hubertus Haas
- Division of Molecular Biology, Innsbruck Medical University, Innsbruck, Austria.
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria; CBmed Center for Biomarker Research in Medicine, Graz, Austria; Division of Pulmonology, Medical University of Graz, Graz, Austria; Division of Infectious Diseases, Department of Medicine, University of California San Diego, San Diego, CA, USA.
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Buchheidt D, Reinwald M, Hofmann WK, Boch T, Spiess B. Evaluating the use of PCR for diagnosing invasive aspergillosis. Expert Rev Mol Diagn 2017; 17:603-610. [PMID: 28460550 DOI: 10.1080/14737159.2017.1325735] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Aspergillus species, primarily Aspergillus fumigatus, are still the most emerging fungal pathogens. Within recent years, novel molecular methods have been developed to improve the diagnosis of life-threatening invasive aspergillosis in high risk patients. Especially patients with malignant hematological diseases undergoing intensive chemotherapy are at risk and mortality rates are exceptionally high, in part due to difficulties and delays in establishing a microbiologic diagnosis. Early diagnosis and treatment are crucial for an adequate therapeutical management, but, however, are hardly achieved in the clinical setting because most of the current conventional diagnostic tools either lack specificity or acceptable sensitivity at the critical early phase of the infection. Areas covered: To review the clinical value, advantages and problems as well as drawbacks of molecular approaches, especially polymerase chain reaction (PCR)-based assays to detect genomic DNA of Aspergillus species in clinical samples of immunocompromised, especially hematological patients at high risk for IA, a comprehensive review of the literature was performed and expert opinion was expressed. Expert commentary: The results of numerous attempts to diagnose invasive aspergillosis by PCR-based detection of fungal genome in clinical samples highlight the potential of the PCR technique to improve early diagnosis of invasive aspergillosis in patients with hematological malignancies during intensive antineoplastic treatment, combined with imaging surveillance and serologic diagnostic tools. Further comparative validation of reliable assays in prospective multicenter studies is mandatory and urgently needed in order to establish a harmonization and standardization, so that 'gold standard assays' may be incorporated into diagnostic and therapeutic algorithms that improve the prognosis of patients with life-threatening infections caused by Aspergillus species.
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Affiliation(s)
- Dieter Buchheidt
- a Department of Internal Medicine -Hematology and Oncology , Mannheim University Hospital, University of Heidelberg , Mannheim , Germany
| | - Mark Reinwald
- a Department of Internal Medicine -Hematology and Oncology , Mannheim University Hospital, University of Heidelberg , Mannheim , Germany
| | - Wolf-Karsten Hofmann
- a Department of Internal Medicine -Hematology and Oncology , Mannheim University Hospital, University of Heidelberg , Mannheim , Germany
| | - Tobias Boch
- a Department of Internal Medicine -Hematology and Oncology , Mannheim University Hospital, University of Heidelberg , Mannheim , Germany
| | - Birgit Spiess
- a Department of Internal Medicine -Hematology and Oncology , Mannheim University Hospital, University of Heidelberg , Mannheim , Germany
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Marchesi F, Spadea A, Pimpinelli F, Prignano G, Paglia MG, Forcella D, Gumenyuk S, Renzi D, Palombi F, Vulcano A, Pisani F, Romano A, Papa E, Facciolo F, Ensoli F, Girmenia C, Mengarelli A. The predictive value of Aspergillus PCR testing on bronchoalveolar lavage fluid for early diagnosis of invasive pulmonary aspergillosis in hematologic patients. Leuk Lymphoma 2017; 58:2943-2946. [PMID: 28482726 DOI: 10.1080/10428194.2017.1315116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Francesco Marchesi
- a Hematology and Stem Cell Transplant Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Antonio Spadea
- a Hematology and Stem Cell Transplant Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Fulvia Pimpinelli
- b Molecular Virology, Pathology and Microbiology Laboratory , San Gallicano Dermatological Institute , Italy
| | - Grazia Prignano
- b Molecular Virology, Pathology and Microbiology Laboratory , San Gallicano Dermatological Institute , Italy
| | - Maria Grazia Paglia
- c Microbiology and Infectious Diseases Biorepository Laboratory , National Institute of Infectious Diseases "L. Spallanzani" , Italy
| | - Daniele Forcella
- d Thoracic Surgery Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Svitlana Gumenyuk
- a Hematology and Stem Cell Transplant Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Daniela Renzi
- a Hematology and Stem Cell Transplant Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Francesca Palombi
- a Hematology and Stem Cell Transplant Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Antonella Vulcano
- c Microbiology and Infectious Diseases Biorepository Laboratory , National Institute of Infectious Diseases "L. Spallanzani" , Italy
| | - Francesco Pisani
- a Hematology and Stem Cell Transplant Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Atelda Romano
- a Hematology and Stem Cell Transplant Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Elena Papa
- a Hematology and Stem Cell Transplant Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Francesco Facciolo
- d Thoracic Surgery Unit , Regina Elena National Cancer Institute , Rome , Italy
| | - Fabrizio Ensoli
- b Molecular Virology, Pathology and Microbiology Laboratory , San Gallicano Dermatological Institute , Italy
| | | | - Andrea Mengarelli
- a Hematology and Stem Cell Transplant Unit , Regina Elena National Cancer Institute , Rome , Italy
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Heldt S, Hoenigl M. Lateral Flow Assays for the Diagnosis of Invasive Aspergillosis: Current Status. CURRENT FUNGAL INFECTION REPORTS 2017; 11:45-51. [PMID: 28680526 PMCID: PMC5487869 DOI: 10.1007/s12281-017-0275-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Diagnosis during early stages of invasive aspergillosis (IA) and targeted antifungal treatment has the potential to improve survival significantly. Despite advances in the diagnostic arsenal, invasive mold infections remain difficult to diagnose-especially at early stages before typical radiological signs develop. Varying availability and time-to-results are important limitations of current approved biomarkers and molecular assays for diagnosis of IA. Here, we will give an update on the Aspergillus-specific lateral-flow device (LFD) test. We further review promising findings on feasibility of point-of-care (POC) detection of urinary excreted fungal galactomannan-like antigens. RECENT FINDINGS POC LFD assays for detection of Aspergillus antigens are currently in development. The Aspergillus-specific LFD test, which is based on the JF5 antibody (Ab), detects an extracellular glycoprotein antigen secreted during active growth of Aspergillus spp. The test has shown promising results in various studies. In addition, a monoclonal Ab476-based LFD for POC detection of urinary excreted fungal galactomannan-like antigens has been developed but needs further validation. SUMMARY Important advances have been made in the development of LFD assays for IA. Most promising is the Aspergillus-specific LFD test; commercial availability is still pending, however. The search for reliable POC tests for other molds, including mucorales, continues.
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Affiliation(s)
- Sven Heldt
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Martin Hoenigl
- Division of Pulmonology, Medical University of Graz, Graz, Austria
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
- CBmed—Center for Biomarker Research in Medicine, Graz, Austria
- Division of Infectious Diseases, Department of Medicine, University of California–San Diego, San Diego, USA
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Wen Z, Wu C, Cui F, Zhang H, Mei B, Shen M. The role of osmolality in saline fluid nebulization after tracheostomy: time for changing? BMC Pulm Med 2016; 16:179. [PMID: 27938371 PMCID: PMC5148908 DOI: 10.1186/s12890-016-0342-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 12/02/2016] [Indexed: 12/12/2022] Open
Abstract
Background Saline fluid nebulization is highly recommend to combat the complications following tracheostomy, yet the understandings on the role of osmolality in saline solution for nebulization remain unclear. Objectives To investigate the biological changes in the early stage after tracheostomy, to verify the efficacy of saline fluid nebulization and explore the potential role of osmolality of saline nebulization after tracheostomy. Methods Sprague-Dawley rats undergone tracheostomy were taken for study model, the sputum viscosity was detected by rotational viscometer, the expressions of TNF-α, AQP4 in bronchoalveolar lavage fluid were assessed by western blot analysis, and the histological changes in endothelium were evaluated by HE staining and scanning electron microscopy (SEM). Results Study results revealed that tracheostomy gave rise to the increase of sputum viscosity, TNF-α and AQP4 expression, mucosa and cilia damage, yet the saline fluid nebulization could significantly decrease the changes of those indicators, besides, the hypertonic, isotonic and hypertonic saline nebulization produced different efficacy. Conclusions Osmolality plays an important role in the saline fluid nebulization after tracheostomy, and 3% saline fluid nebulization seems to be more beneficial, further studies on the role of osmolality in saline fluid nebulization are warranted.
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Affiliation(s)
- Zunjia Wen
- Nursing School of Soochow University, Su Zhou, People's Republic of China
| | - Chao Wu
- Nursing School of Soochow University, Su Zhou, People's Republic of China
| | - Feifei Cui
- Neurosurgery Department of First Hospital Affiliated to Soochow University, No. 188 Shizi Street, Gusu District, Su Zhou, Jiangsu Province, People's Republic of China
| | - Haiying Zhang
- Neurosurgery Department of First Hospital Affiliated to Soochow University, No. 188 Shizi Street, Gusu District, Su Zhou, Jiangsu Province, People's Republic of China
| | - Binbin Mei
- Nursing School of Soochow University, Su Zhou, People's Republic of China
| | - Meifen Shen
- Neurosurgery Department of First Hospital Affiliated to Soochow University, No. 188 Shizi Street, Gusu District, Su Zhou, Jiangsu Province, People's Republic of China.
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Misch EA, Safdar N. Updated guidelines for the diagnosis and management of aspergillosis. J Thorac Dis 2016; 8:E1771-E1776. [PMID: 28149638 DOI: 10.21037/jtd.2016.12.76] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Elizabeth Ann Misch
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nasia Safdar
- Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA; ; William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
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